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DEPARTMENT OF INDUSTRIAL RELATIONS DID CAB FORM 10 (REV. 7 /81) STATE OF CALIFORNIA WORKERS' COMPENSATION APPEALS BOARD ANSWER OF Case No. (INJURED EMPLOYEE) Date of alleged injury: vs. (CORRECT NAME
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How to fill out dia wcab form 10
How to fill out dia wcab form 10:
01
Start by obtaining the dia wcab form 10 from the appropriate source, such as your employer or the Workers' Compensation Appeals Board (WCAB) website.
02
Fill in your personal information accurately, including your full name, address, social security number, and contact details.
03
Provide details about your employer, such as their name, address, and contact information.
04
Indicate the date and time of your injury or illness, as well as the location where it occurred.
05
Describe how the injury or illness happened, providing specific details and any relevant factors that contributed to the incident.
06
Include the names and addresses of any witnesses to the incident, if applicable.
07
Specify the body parts affected by the injury or illness, providing a detailed description of the symptoms and any medical treatment received.
08
Ensure all sections of the form are complete and accurate before submitting it.
09
Submit the filled-out form to the appropriate entity, such as your employer or the WCAB, as instructed.
Who needs dia wcab form 10:
01
Employees who have suffered a work-related injury or illness and wish to file a workers' compensation claim.
02
Employers who are responsible for reporting workplace injuries or illnesses to the appropriate authorities.
03
Insurance providers and legal professionals who may require the information provided in dia wcab form 10 for claim processing or legal proceedings.
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